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  • Writer's pictureJay Kasthuriarachchi

RED- S and Destigmatizing the Period in Sport

Red- S (known as Relative Energy Deficiency in Sport) is a condition that occurs mostly in women who are active. It basic terms it is when the energy input (i.e food, calories, etc) is below the energy output (exercise).


It can occur for a number reasons

- Overtraining

- Under eating

- Psychological/mental health issues that cause under eating or over training (such as bulimia or anorexia).



In this environment, the body switches into survival mode, and turns off systems that in deems not necessary to survive, such as the menstrual cycle. By this time however, RED- S has well and truly set in.


Other signs and symptoms include

- Stress fractures or stress reactions. Due to poor nutrition, the bones natural remodelling process in compromised.

- A history of disorganised eating (such as bulimia or anorexia)

- Easily fatigued

- Hair loss (due to a decrease in estrogen)


Note that the pill creates a synthetic period, so simply relying on the menstrual cycle to diagnose RED- S will not be enough.


Treatment for RED- S is multi pronged.


Firstly, the presenting symptoms must be treated. This is commonly the reason for a patient presenting to physiotherapy ("my foot hurts", "my hip hurts").


Secondly (and most importantly) RED- S must be treated. This will involve talking to a sports doctor to discuss potential medication, a dietician for dietary advice and in some cases talking to a psychologist if there are potential psychological barriers. Lastly, if there is a personal trainer or a strength and conditioning coach involved in the patients management, then they too should be involved.


In terms of recovery time, following a stress fracture due to the effects of RED- S, it can take up to 3 months for new bone to be replaced. Which means that it is vital that it is picked up early.


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